JP3637369B2 - Pin to fix the graft ligament to the bone - Google Patents

Pin to fix the graft ligament to the bone Download PDF

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JP3637369B2
JP3637369B2 JP51636594A JP51636594A JP3637369B2 JP 3637369 B2 JP3637369 B2 JP 3637369B2 JP 51636594 A JP51636594 A JP 51636594A JP 51636594 A JP51636594 A JP 51636594A JP 3637369 B2 JP3637369 B2 JP 3637369B2
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pin
bone
tunnel
head
ligament
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JPH08505549A (en
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ゴーブル，イー．，マーロー
ローアー，ジェリー，エル．
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デピュイ オーソピーディックス，インコーポレイテッド
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/08—Muscles; Tendons; Ligaments
    • A61F2/0811—Fixation devices for tendons or ligaments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
    • A61B17/86—Pins or screws or threaded wires; nuts therefor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/38—Joints for elbows or knees
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/08—Muscles; Tendons; Ligaments
    • A61F2/0811—Fixation devices for tendons or ligaments
    • A61F2002/0817—Structure of the anchor
    • A61F2002/0823—Modular anchors comprising a plurality of separate parts
    • A61F2002/0829—Modular anchors comprising a plurality of separate parts without deformation of anchor parts, e.g. fixation screws on bone surface, extending barbs, cams, butterflies, spring-loaded pins
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/08—Muscles; Tendons; Ligaments
    • A61F2/0811—Fixation devices for tendons or ligaments
    • A61F2002/0847—Mode of fixation of anchor to tendon or ligament
    • A61F2002/087—Anchor integrated into tendons, e.g. bone blocks, integrated rings
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/08—Muscles; Tendons; Ligaments
    • A61F2/0811—Fixation devices for tendons or ligaments
    • A61F2002/0876—Position of anchor in respect to the bone
    • A61F2002/0882—Anchor in or on top of a bone tunnel, i.e. a hole running through the entire bone

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  • Health & Medical Sciences (AREA)
  • Biomedical Technology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Cardiology (AREA)
  • Vascular Medicine (AREA)
  • Transplantation (AREA)
  • Engineering & Computer Science (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Rheumatology (AREA)
  • Rehabilitation Therapy (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Prostheses (AREA)
  • Surgical Instruments (AREA)

Abstract

A pin is provided for securing a replacement ligament inside a tunnel of a receptor bone. The pin includes a body portion having a threaded section for engaging the receptor bone to anchor the pin in the receptor bone. The body portion also includes a tapered shank located adjacent the threaded portion. The tapered shank is configured to enter a drilled hole having a predetermined diameter formed in the replacement ligament to force the replacement ligament against the wall of the tunnel. The tapered shank has a first diameter at a first end of the tapered shank opposite the threaded portion which is smaller than the predetermined diameter of the drilled hole and a second diameter adjacent the threaded portion which is larger than the predetermined diameter so that the tapered shank engages the replacement ligament in the tunnel as the pin is inserted through the drilled hole in the replacement ligament to force the replacement ligament against a side wall of the tunnel to promote healing of the replacement ligament within the receptor bone. The pin further includes a head coupled to an end of the body portion adjacent the threaded section for driving the pin into the receptor bone.

Description

（技術分野・背景技術・発明の開示及び産業上の利用可能性）
本出願は骨の形成したトンネル内部に移植靭帯を固定するためのピンに関する。特に、本発明は骨内に移植靭帯移植片を固定するのを容易にし、骨内の靭帯移植片の治癒を促進するピンに関する。
膝の前十字靭帯（ACL）を損傷又は断裂した場合に移植靭帯を膝に装着して自然な前十字靭帯の再建を図ることが多い。こうした再建術の場合、一般に脛骨前部から上向きに脛骨平坦部を通り大腿骨遠心端へと前十字靭帯の自然な位置に近づけるように穿孔する。骨−靭帯−骨移植片を標準的移植術に準拠して膝蓋骨側から挿入する。一般に楔状の移植片を切り取り移植ガイドを用いて成型する。次に結紮孔を移植片に形成する。この後、移植片を穿孔したトンネル内に装着する。
脛骨と大腿骨内部の移植片が治癒するまで固定しておくための方法は公知である。こうした方法の１つとしてクロサカ（「Kurosaka」，商標）固定ねじの使用があげられる。クロサカねじはトンネル内部で移植片との干渉嵌合を提供して、トンネル壁に対して移植片がくさびとして機能する。これについては例えば米国特許第4,950,270号を参照されたい。
他の公知の方法では移植片に結合した縫合糸を骨に結合するのにねじ又はワッシャを用いる。靭帯もプレート又はワッシャを用いて骨に直接結合させることが出切る。
更に穿孔したトンネルを横断してトンネル内に移植片を固定するピンを用いる方法が公知である。穿孔したトンネルを横断するピンの位置を合わせて靭帯移植片を骨に固定するための様々な装置と方法が公知である。例えば米国特許第4,901,711号並びに米国特許第4,985,032号を参照されたい。
移植靭帯を骨に固定するための横断ピンの位置を決めて装着するためのその他の方法及びその装置は、ゴッブルとロワー（Goble and Lower）による骨内に靭帯移植片を固定するための方法（METHOD FOR SECURING A LIGAMENT REPLACEMENT IN A BONE）と題する米国特許出願第08/004,987号及びゴッブルとロワーによる穿孔案内装置（DRILL GUIDE APPARATUS）と題する米国特許出願第08/004,958号に開示されている。
本発明のピンは従来技術による横断ピン及びねじに対して利点を提供するものである。ピンは平滑な軸を含み、骨移植片の骨片をトンネルの一側に対して押し付けることで骨内の移植片の治癒を促進するようにテーパー状にするのが望ましい。テーパー状の軸は靭帯移植片の一部をトンネル壁に押し付ける又は圧接して治癒と接着を促進するための手段を構成する。更に平滑な軸は移植靭帯を使用する場合などに移植靭帯を配置する又は巻き付ける表面を提供する。
本発明のピンはピンのねじを切ってある部分から離れた頭部を含み、ピンの頭部が大腿骨の骨皮質と係合して頭部が大腿骨に埋没しないようにしている。これにより、ピンの抜去が必要な場合には皮膚を通してピンの所在を簡単に特定できる。本発明のピンは前述のクロサカ干渉ねじに比べて容易に抜去できる。すでに述べたように、本発明のピンへの到達は膝関節の実質的な侵襲無しに得られる。
本発明の１つの態様によれば、受け入れ側の骨のトンネル内部に移植靭帯を固定するためのピンが提供される。このピンは受け入れ側の骨に係合して、受け入れ側の骨にピンを固定するためのねじを切ってある部分を有する本体部分を含む。本体部分は移植靭帯と係合して、移植靭帯をトンネルの側壁に圧接し、トンネル内部での移植靭帯の固定と靭帯の治癒の促進のための手段も含む。ピンは更に受け入れ側の骨にピンを打ち込むためにねじを切った部分と隣接して本体部分の端部に結合した頭部を含む。
図示した実施例において、係合手段はねじ切りした部分に隣接するテーパー状の軸を含む。テーパー状の軸は移植靭帯に所定の直径で形成してある穿孔に挿入して移植靭帯をトンネルの壁に対して圧接するように構成してある。テーパー状の軸はねじ切りした部分に対向するテーパー状の軸の第１の端部で穿孔した孔の所定の直径より小さい第１の直径を有する。テーパー状の軸はねじ切りした部分の近くで所定の直径より大きな第２の直径を有して穿孔を通してピンを移植靭帯に挿入したときにテーパー状の軸がトンネル内で移植靭帯と係合し移植靭帯をトンネルの側壁に対して圧接し受け入れ側の骨の内部で移植靭帯の治癒を促進するようにしてある。
また図示した実施例において、ピンは一般に円錐形で頭部に対向する本体部分の端部に位置する先端を含む。一般に円錐形の先端は約30゜の角度を付けて図示してある。
図示した実施例は更に頭部と本体部分のねじ切りした部分の間に位置する一般に平滑な剄部を含む。剄部はピンの骨からの抜去を容易にする。頭部は外周部が六角形でピンを受け入れ側の骨に装着したときに受け入れ側の骨に頭部が埋没してしまう危険性を減少させている。
本発明の更なる目的、特徴、及び利点は現時点で認知されている本発明を実現するための最良の形態を例示した好適実施例についての以下の詳細な説明の勘案から当業者には明らかとなろう。
【図面の簡単な説明】
以下の詳細な説明では特に添付の図面を参照する。図面において、
図１は移植靭帯を骨内に形成した穿孔トンネル内部に固定する又は保定するための本発明のピンの側面図である。
図２は大腿骨を貫通し骨内のトンネルを貫通しトンネル内に配置した靭帯移植片を貫通しトンネルの対向する側面の骨内に進入するピンを図示した部分切り欠き図である。
（発明を実施するための最良の形態）
ここで図面を参照すると、図１では本発明のピン10が図示してある。ピン10は内側の縁部13を有する頭部12と、頭部12に隣接する剄部14と、ねじ切りした部分16と、一般に平滑な軸18と、一般に円錐形の先端20を含む。先端20は図面上では平滑なテーパー状の尖頭部を有するように図示してある。尖頭部22は鈍角で平滑又は尖らせないでおきピンを挿入したときに骨移植片を貫通しないようにしてある。先端20は角度23で図示したように約30゜の円錐形である。先端20は骨を貫通して穿孔した孔を通り移植靭帯に形成した孔を貫通してピン10を案内するような形状にしてある。ある種の用途において、円錐形の先端20の尖頭部を尖らせておき尖った尖頭部がピン10の頭部12に対向する骨トンネルの側面において骨内に刺さるようにしてもよい。
ピン10の平滑な軸18はわずかにテーパー状を成すのが望ましい。寸法24で図示した先端20に近い部分の軸18の直径は約0.092インチ（0.234cm）である。直径26で図示したねじ切り部分16に近い軸18の基部の直径は直径24より大きい。図面において直径26は約0.112インチ（0.284 cm）である。
ピン10は寸法27で図示した長さを有し、これは骨内に靭帯移植片を確実に固定するのに必要な寸法によって変化する。図面上では寸法27で図示した長さは35mm、40mm、45mm、50mm、55mm、60mm又は用途によって必要とされるほかの長さとすることが出来る。各々の長さで先端12の端部から軸18に接するねじ切りした部分16の端部までの寸法29で図示した長さは約0.5インチ（1.27cm）である。先端12の端部からねじ切りした部分16に接する頸部14の端部までの寸法31で図示した長さは約0.18インチ（0.457cm）である。先端12の端部から先端12の内側縁部13までの寸法33で示した長さは約0.1インチ（0.254c m）である。
頭部12は図面においては外側が六角形の頭部である。六角形の頭部12は平滑な剄部14でねじ切りした部分16と隔てられている。外部の六角形はアレンねじ又は溝つき頭部より頭部12に好適である。外部が六角形の頭部12はピンを骨内に打ち込んだときに頭部が埋没してしまう危険性を減少させるものである。頭部12が埋没し始めた場合には、外部六角形のドライバー（図示していない）で頭部12を引き出せる。
図２は膝関節の大腿骨へ前十字靭帯移植片を保定するために使用するピン10を示す。図２では脛骨30と大腿骨32を含む膝関節28が図示してある。前十字靭帯の移植中に脛骨32の前側表面を上向きに貫通し、脛骨平坦部36を貫通して大腿骨32までの穿孔によりトンネル34を形成する。一般に、トンネル34はトンネルの所望の経路にそって案内ピン又はＫワイヤを通ることで形成する。Ｋワイヤは脛骨30と大腿骨32を通る開口部46を形成する。カニューレ挿入したドリル（図示していない）を普通通りに使用してＫワイヤの経路にそってトンネル34を形成する。
トンネル34を骨内に形成した後、移植靭帯をトンネル34に挿入する。図２の実施例では、図示した移植靭帯は骨部又は骨栓38と靭帯部分40を有する切り出した移植片を含む。他方の骨部又は骨栓（図示していない）は脛骨30内のトンネル34に配置する。横断方向の案内孔は大腿骨32、トンネル34、骨移植片38を貫通して穿孔する。案内孔42はトンネル34の対向する側面の大腿骨32の一部にまで延在する。
一般的に、案内孔42はピン10の平滑な軸18の寸法24と寸法26の中間の大きさの直径を有するドリルで形成する。図面において、案内孔42の直径は約2.5mm（0.0984インチ）である。したがって、先端20と先端20に近い軸18の部分は孔42を形成する壁と密に係合することなく移植片38内の孔42を貫通する。しかしテーパー状の軸18は孔42の直径より大きい直径を有するテーパー状の軸18が移植片38の孔42を通って移動すると移植片38を通る案内孔42を形成する側壁と係合するようになる。そのため、ピン10のテーパー状の軸18から矢印44の方向に移植片38と直角に力がかかり、移植片をトンネル34の壁に対して圧接する。移植片38をトンネル34の壁に対して圧接することで、ピン10は大腿骨32内部に移植片38を固定し、かつ移植片38の治癒並びに接着を促進する。
ピン10の平滑な軸18はトンネル34を横断する方向に架橋する。したがって図２に図示したような骨栓靭帯移植片の代わりにピン10の回りに移植靭帯を巻き付ける技術においてピン10を使用することも可能である。
ねじ切りした部分16は大腿骨32の硬骨に食い込み大腿骨32内にピン10を保定する。前述のように、外部が六角形の頭部12は頭部12が大腿骨32内に埋没する可能性を減少させるものである。縁部13は大腿骨32の外部表面と係合しようとする。頭部12は大腿骨32の表面に着座する。したがって六角形の頭部12は患者の皮膚を通して位置を特定できるので、治癒後または靭帯移植に失敗した場合に小さい皮切を経由して比較的簡単にピン10を抜去することが出来る。
ピン10を大腿骨32から抜去するとき、ねじ16が大腿骨32から後退する。ねじ切りした部分16の端部が大腿骨32からはずれると、ピン10は回転させたときに単に空回りするだけである。つまり、剄部14はとげ抜きに似た装置（図示していない）でピン10を把持して大腿骨32から抜去できるようにする領域を提供する。
ある種の好適実施例を参照して本発明を詳細に説明したが、添付の請求の範囲に記載しまた定めるとおりの本発明の範囲及び趣旨に適合する変化及び変更が存在する。(Technical field, background art, disclosure of invention and industrial applicability)
The present application relates to a pin for securing a graft ligament within a bone-formed tunnel. In particular, the present invention relates to a pin that facilitates fixation of a graft ligament graft within the bone and promotes healing of the ligament graft within the bone.
When the anterior cruciate ligament (ACL) of the knee is damaged or torn, a graft ligament is often attached to the knee to reconstruct the natural anterior cruciate ligament. In the case of such reconstruction, a perforation is generally made so as to approach the natural position of the anterior cruciate ligament from the anterior tibia through the flat tibia to the distal end of the femur. A bone-ligament-bone graft is inserted from the patella side according to standard grafting procedures. Generally, a wedge-shaped graft is cut out and molded using a transplant guide. A ligature is then formed in the graft. After this, the graft is mounted in a drilled tunnel.
Methods for keeping the tibia and femur internal grafts fixed until they heal are known. One such method is the use of Kurosaka ("Kurosaka", trademark) fixing screws. The Kurosaka screw provides an interference fit with the implant inside the tunnel so that the implant acts as a wedge against the tunnel wall. See for example US Pat. No. 4,950,270.
Other known methods use screws or washers to join sutures attached to the graft to the bone. The ligament can also be directly attached to the bone using a plate or washer.
In addition, methods are known that use pins to secure the graft in the tunnel across the drilled tunnel. Various devices and methods are known for aligning pins across a drilled tunnel to secure a ligament graft to a bone. See, for example, US Pat. No. 4,901,711 and US Pat. No. 4,985,032.
Other methods and apparatus for positioning and mounting a transverse pin for securing a graft ligament to bone include a method for securing a ligament graft within a bone by Goble and Lower ( U.S. Patent Application No. 08 / 004,987 entitled METHOD FOR SECURING A LIGAMENT REPLACEMENT IN A BONE) and U.S. Patent Application No. 08 / 004,958 entitled DRILL GUIDE APPARATUS.
The pin of the present invention provides advantages over prior art transverse pins and screws. The pin preferably includes a smooth shaft and is tapered to promote healing of the implant within the bone by pressing the bone graft bone against one side of the tunnel. The tapered shaft constitutes a means for pressing or pressing a portion of the ligament graft against the tunnel wall to promote healing and adhesion. The smoother shaft provides a surface on which to place or wrap the graft ligament, such as when using the graft ligament.
The pin of the present invention includes a head that is remote from the unthreaded portion of the pin so that the head of the pin engages the bone cortex of the femur so that the head is not buried in the femur. This makes it easy to identify the location of the pin through the skin when it is necessary to remove the pin. The pin of the present invention can be easily removed as compared with the aforementioned Kurosaka interference screw. As already mentioned, reaching the pin of the present invention is obtained without substantial invasion of the knee joint.
In accordance with one aspect of the present invention, a pin is provided for securing a graft ligament within a receiving bone tunnel. The pin includes a body portion having a threaded portion for engaging the receiving bone and securing the pin to the receiving bone. The body portion also engages the graft ligament to press the graft ligament against the tunnel sidewall and also includes means for securing the graft ligament within the tunnel and promoting healing of the ligament. The pin further includes a head coupled to the end of the body portion adjacent to the threaded portion for driving the pin into the receiving bone.
In the illustrated embodiment, the engagement means includes a tapered shaft adjacent to the threaded portion. The tapered shaft is inserted into a perforation formed with a predetermined diameter in the graft ligament so as to press the graft ligament against the tunnel wall. The tapered shaft has a first diameter that is smaller than a predetermined diameter of the hole drilled at the first end of the tapered shaft opposite the threaded portion. The tapered shaft has a second diameter greater than a predetermined diameter near the threaded portion, and the tapered shaft engages the graft ligament in the tunnel when the pin is inserted into the graft ligament through the perforation. The ligament is pressed against the side wall of the tunnel to promote the healing of the graft ligament within the receiving bone.
Also in the illustrated embodiment, the pin is generally conical and includes a tip located at the end of the body portion opposite the head. In general, the conical tip is shown at an angle of about 30 °.
The illustrated embodiment further includes a generally smooth collar located between the head and the threaded portion of the body portion. The buttock facilitates removal of the pin from the bone. The head has a hexagonal outer periphery and reduces the risk of the head being buried in the receiving bone when the pin is mounted on the receiving bone.
Further objects, features, and advantages of the present invention will become apparent to those skilled in the art from consideration of the following detailed description of the preferred embodiment, illustrating the best mode for carrying out the invention, as currently recognized. Become.
[Brief description of the drawings]
The following detailed description particularly refers to the accompanying drawings. In the drawing
FIG. 1 is a side view of a pin of the present invention for securing or retaining a graft ligament within a perforated tunnel formed in bone.
FIG. 2 is a partial cutaway view illustrating a pin that penetrates the femur, penetrates the tunnel in the bone, penetrates the ligament graft placed in the tunnel, and enters the bone on the opposite side of the tunnel.
(Best Mode for Carrying Out the Invention)
Referring now to the drawings, FIG. 1 illustrates a pin 10 of the present invention. The pin 10 includes a head 12 having an inner edge 13, a collar 14 adjacent to the head 12, a threaded portion 16, a generally smooth shaft 18, and a generally conical tip 20. The tip 20 is shown as having a smooth tapered point in the drawing. The pointed head 22 is obtuse and smooth or unsharped so that it does not penetrate the bone graft when the pin is inserted. The tip 20 has a cone shape of about 30 ° as illustrated at an angle 23. The tip 20 is shaped to guide the pin 10 through a hole formed in the graft ligament through a hole drilled through the bone. In certain applications, the cusp of the conical tip 20 may be sharpened so that the pointed cusp is pierced into the bone on the side of the bone tunnel facing the head 12 of the pin 10.
The smooth shaft 18 of the pin 10 is preferably slightly tapered. The diameter of the shaft 18 near the tip 20 illustrated at dimension 24 is about 0.092 inch (0.234 cm) . The diameter of the base of the shaft 18 close to the threaded portion 16 illustrated by the diameter 26 is larger than the diameter 24. In the drawing, diameter 26 is approximately 0.112 inches (0.284 cm) .
The pin 10 has a length as illustrated by dimension 27, which varies depending on the dimension required to securely secure the ligament graft within the bone. In the drawing, the length illustrated by dimension 27 can be 35 mm, 40 mm, 45 mm, 50 mm, 55 mm, 60 mm or any other length required by the application. The length illustrated for each length 29 from the end of the tip 12 to the end of the threaded portion 16 in contact with the shaft 18 is approximately 0.5 inches (1.27 cm) . The length illustrated with dimension 31 from the end of the tip 12 to the end of the neck 14 in contact with the threaded portion 16 is about 0.18 inch (0.457 cm) . The length indicated by the dimension 33 from the end of the tip 12 to the inner edge 13 of the tip 12 is about 0.1 inch (0.254 cm) .
The head 12 is a hexagonal head on the outside in the drawing. The hexagonal head 12 is separated from the threaded portion 16 by a smooth collar 14. The external hexagon is more suitable for the head 12 than the Allen screw or grooved head. The external hexagonal head 12 reduces the risk of the head being buried when a pin is driven into the bone. When the head 12 starts to be buried, the head 12 can be pulled out with an external hexagonal screwdriver (not shown).
FIG. 2 shows a pin 10 used to retain the anterior cruciate ligament graft to the femur of the knee joint. In FIG. 2, a knee joint 28 including a tibia 30 and a femur 32 is shown. During anterior cruciate ligament implantation, the anterior surface of the tibia 32 is penetrated upward and a tunnel 34 is formed by drilling through the tibial flat 36 to the femur 32. Generally, the tunnel 34 is formed by passing guide pins or K-wires along the desired path of the tunnel. The K wire forms an opening 46 through the tibia 30 and the femur 32. A tunnel 34 is formed along the path of the K-wire using a cannulated drill (not shown) as usual.
After the tunnel 34 is formed in the bone, the graft ligament is inserted into the tunnel 34. In the embodiment of FIG. 2, the illustrated graft ligament includes a cut graft having a bone or bone plug 38 and a ligament portion 40. The other bone or bone plug (not shown) is placed in a tunnel 34 in the tibia 30. A transverse guide hole is drilled through the femur 32, tunnel 34, and bone graft 38. The guide hole 42 extends to a portion of the femur 32 on the opposite side of the tunnel 34.
Generally, the guide hole 42 is formed by a drill having a diameter that is intermediate between the dimension 24 and the dimension 26 of the smooth shaft 18 of the pin 10. In the drawing, the diameter of the guide hole 42 is about 2.5 mm (0.0984 inch). Accordingly, the tip 20 and the portion of the shaft 18 near the tip 20 penetrates the hole 42 in the graft 38 without closely engaging the wall forming the hole 42. However, the tapered shaft 18 engages the side wall forming the guide hole 42 through the graft 38 as the tapered shaft 18 having a diameter greater than the diameter of the hole 42 moves through the hole 42 in the graft 38. become. Therefore, a force is applied from the tapered shaft 18 of the pin 10 in the direction of the arrow 44 in a direction perpendicular to the graft 38 to press the graft against the wall of the tunnel 34. By pressing the graft 38 against the wall of the tunnel 34, the pin 10 secures the graft 38 within the femur 32 and promotes healing and adhesion of the graft 38.
The smooth axis 18 of the pin 10 bridges in the direction across the tunnel 34. Thus, it is possible to use the pin 10 in a technique for wrapping the graft ligament around the pin 10 instead of the bone plug ligament graft as illustrated in FIG.
The threaded portion 16 bites into the bone of the femur 32 and holds the pin 10 in the femur 32. As described above, the externally hexagonal head 12 reduces the possibility of the head 12 being buried in the femur 32. The edge 13 attempts to engage the outer surface of the femur 32. The head 12 sits on the surface of the femur 32. Thus, the hexagonal head 12 can be located through the patient's skin so that the pin 10 can be removed relatively easily via a small skin incision after healing or if ligament implantation fails.
When the pin 10 is removed from the femur 32, the screw 16 is retracted from the femur 32. If the end of the threaded portion 16 is disengaged from the femur 32 , the pin 10 simply turns idle when rotated. That is, the heel 14 provides a region that allows the pin 10 to be grasped and removed from the femur 32 with a device (not shown) similar to barb.
Although the invention has been described in detail with reference to certain preferred embodiments, there are changes and modifications that fall within the scope and spirit of the invention as set forth and defined in the appended claims.

Claims (22)

受け入れ側の骨のトンネルの内部に移植靭帯を固定するためのピンであって、
前記受け入れ側の骨と係合して、前記受け入れ側の骨に前記ピンを固定するためのねじ切りした部分を含み、更に前記移植靭帯と係合しくさび式に止めて、前記移植靭帯を前記トンネルの側壁に対して圧接することで、前記移植靭帯をトンネル内部に固定し前記靭帯の治癒を促進するための手段を含む本体部分を有し、
ここで前記移植靭帯と係合しくさび式に止める前記手段は、平滑な円錐形状を有し、その円形断面が大きなほうの基部は前記ねじ切りした部分の方を向いており、その小さなほうの円形断面は前記基部よりも前記ねじ切りした部分から遠い位置に配置されており、
前記本体部分は更に、前記係合しくさび式に止める手段に一端が近接するテーパー状の先端部分を含んでおり、
前記ピンは更に、前記ねじ切りした部分に接する前記本体部分の端部に結合し、前記ピンを前記受け入れ側の骨に打ち込むための頭部を含むことを特徴とするピン。A pin for fixing the graft ligament inside the bone tunnel on the receiving side,
A threaded portion for engaging the receiving bone to secure the pin to the receiving bone, and further engaged and wedged with the graft ligament to secure the graft ligament to the tunnel A body portion including means for fixing the graft ligament inside the tunnel and promoting healing of the ligament by being pressed against the side wall of
The means for engaging and wedge-engaging with the graft ligament here has a smooth conical shape, the base of which the circular cross section is larger faces the threaded part, the smaller round The cross section is arranged at a position farther from the threaded portion than the base,
The body portion further includes a tapered tip portion having one end proximate to the engaging and wedge-fastening means;
The pin further comprising a head coupled to an end of the body portion that contacts the threaded portion and for driving the pin into the receiving bone. 受け入れ側の骨のトンネルの内部に移植靭帯を固定するためのピンであって、
前記受け入れ側の骨と係合して、前記受け入れ側の骨に前記ピンを固定するためのねじ切りした部分を含み、前記移植靭帯を前記トンネルの側壁に対して圧接することで、前記移植靭帯をトンネル内部に固定し前記靭帯の治癒を促進するために前記移植靭帯と係合しくさび式に止めるための手段を含む本体部分を有し、
前記本体部分は更に、前記係合しくさび式に止める手段に一端が近接するテーパー状の先端部分を含んでおり、
前記ピンは更に、前記ねじ切りした部分に接する前記本体部分の端部に結合し、前記ピンを前記受け入れ側の骨に打ち込むための頭部を含み、ここで前記係合しくさび式に止める前記手段は、前記ねじ切りした部分に隣接して位置するテーパー状の軸を含み、前記テーパー状の軸は、前記移植靭帯に形成した所定の直径を有する穿孔した孔に挿入されて、前記移植靭帯を前記トンネルの前記壁に対して圧接するように構成されていることを特徴とするピン。A pin for fixing the graft ligament inside the bone tunnel on the receiving side,
A threaded portion for engaging the receiving bone and securing the pin to the receiving bone, and pressing the graft ligament against a side wall of the tunnel to Having a body portion including means for engaging and wedge-engaging with the graft ligament to secure inside the tunnel and promote healing of the ligament,
The body portion further includes a tapered tip portion having one end proximate to the engaging and wedge-fastening means;
The pin further includes a head coupled to an end of the body portion that contacts the threaded portion and for driving the pin into the receiving bone, wherein the means is adapted to stop the engagement wedge. Includes a tapered shaft located adjacent to the threaded portion, the tapered shaft being inserted into a perforated hole having a predetermined diameter formed in the graft ligament to A pin configured to be pressed against the wall of the tunnel. 前記テーパー状の軸は、前記ねじ切りした部分に対向する前記テーパー状の軸の第１の端部で前記穿孔した孔の前記所定の直径より小さな第１の直径と、前記ねじ切りした部分に隣接し前記所定の直径より大きな第２の直径とを有して、前記移植靭帯内の穿孔した孔を通して前記ピンを挿入したときに、前記テーパー状の軸が前記トンネル内で前記移植靭帯と係合し、前記トンネルの側壁に対して前記移植靭帯を圧接することで、前記受け入れ側の骨の内部で前記移植靭帯の治癒を促進するようにしてあることを特徴とする請求の範囲第２項に記載のピン。The tapered shaft is adjacent to the threaded portion and a first diameter smaller than the predetermined diameter of the hole drilled at the first end of the tapered shaft facing the threaded portion. The tapered shaft engages the graft ligament in the tunnel when the pin is inserted through a drilled hole in the graft ligament having a second diameter greater than the predetermined diameter. 3. The healing of the transplanted ligament is promoted inside the receiving bone by pressing the transplanted ligament against the side wall of the tunnel. Pin. 前記先端部分が概略円錐形の先端であって、前記頭部とは反対側の前記本体部分の一端に配置されていることを特徴とする請求の範囲第１項に記載のピン。2. The pin according to claim 1, wherein the tip portion is a tip having a substantially conical shape, and is disposed at one end of the main body portion opposite to the head portion. 前記一般に円錐形の尖端部は約30゜の角度に角度づけしていることを特徴とする請求の範囲第４項に記載のピン。5. A pin according to claim 4 wherein said generally conical point is angled at an angle of about 30 degrees. 前記先端と前記本体部分の前記ねじ切りした部分の間に位置する一般に平滑な頸部を更に含むことを特徴とする請求の範囲第１項に記載のピン。The pin of claim 1 further comprising a generally smooth neck located between the tip and the threaded portion of the body portion. 前記頭部を外部が六角形の頭部とすることにより、前記ピンを前記受け入れ側の骨に装着した場合に、前記受け入れ側の骨に前記頭部が埋没する危険性を減少させることを特徴とする請求の範囲第１項に記載のピン。By making the head a hexagonal head outside, the risk of the head being buried in the receiving bone is reduced when the pin is attached to the receiving bone. The pin according to claim 1. 前記頭部から対向する前記本体部分の第２の端部に形成して、前記頭部に対向する前記トンネルの側面において前記受け入れ側の骨の一部に刺入するようにした鋭利な尖端部を更に含むことを特徴とする請求の範囲第１項に記載のピン。A sharp point formed at the second end of the main body portion facing the head so as to be inserted into a part of the bone on the receiving side on the side surface of the tunnel facing the head. The pin according to claim 1, further comprising: 受け入れ側の骨に形成したトンネル内に移植靭帯を保定するためのピンであって、前記ピンは前記受け入れ側の骨と、前記トンネルと、前記トンネル内に配置した前記移植靭帯と、前記トンネルの対向する側面において前記受け入れ側の骨の一部とを貫通して穿孔した横断方向の孔に挿入され、前記穿孔した孔は所定の直径を有し、
前記ピンは、本体部分と、前記ピンを前記受け入れ側の骨に打ち込むために前記本体部分の一端に形成した頭部とを含み、
前記本体部分は、前記頭部に対向して前記本体部分の端部に位置するテーパー状の尖端部と、前記尖端部に隣接して配置され且つテーパー度合いが前記尖端部とは異なる概略平滑なテーパー状の軸と、前記ピンを前記受け入れ側の骨の内部に保定するために前記受け入れ側の骨と係合させる前記軸と前記頭部の間に配置されたねじ切り部分とを含み、前記テーパー状の軸は前記横断方向の孔の前記所定の直径より小さく前記テーパー状の尖端部に隣接した第１の直径と、前記所定の直径より大きい前記ねじ切り部分に隣接した第２の直径とを有して前記ピンを前記移植靭帯内の前記孔を通して挿入したときに前記テーパー状の軸が前記トンネル内の前記移植靭帯に係合して、前記トンネルの側壁に対して前記移植靭帯を圧接し、前記受け入れ側の骨の内部で前記移植靭帯の治癒を促進するようにしてあることを特徴とするピン。A pin for retaining a graft ligament in a tunnel formed in a receiving bone, wherein the pin is the receiving bone, the tunnel, the transplant ligament disposed in the tunnel, and the tunnel Inserted in a transverse hole drilled through the receiving side bone portion on the opposite side, the drilled hole having a predetermined diameter;
The pin includes a body portion and a head formed at one end of the body portion to drive the pin into the receiving bone;
The main body portion is opposed to the head portion and has a tapered pointed end located at the end of the main body portion, and is disposed adjacent to the pointed end and is substantially smooth and different in taper from the pointed end. A tapered shaft and a threaded portion disposed between the shaft and the head for engaging the receiving bone to retain the pin within the receiving bone, the taper The shaft has a first diameter less than the predetermined diameter of the transverse hole and adjacent to the tapered tip and a second diameter adjacent to the threaded portion that is greater than the predetermined diameter. When the pin is inserted through the hole in the graft ligament, the tapered shaft engages the graft ligament in the tunnel, and presses the graft ligament against the side wall of the tunnel, The acceptance Pins, characterized in that the inside of the bone are as promote healing of the graft ligament. 前記本体部分の前記尖端部は一般に円錐形の形状を有することを特徴とする請求の範囲第９項に記載のピン。10. A pin according to claim 9 wherein the tip of the body portion has a generally conical shape. 前記一般に円錐形の尖端部は約30゜の角度に角度づけしていることを特徴とする請求の範囲第10項に記載のピン。11. A pin according to claim 10, wherein said generally conical tip is angled at an angle of about 30 degrees. 前記頭部と前記本体部分のねじ切りした部分の間に配置した一般に平滑な頸部を更に含むことを特徴とする請求の範囲第９項に記載のピン。The pin of claim 9, further comprising a generally smooth neck disposed between the head and a threaded portion of the body portion. 前記頭部を外部が六角形の頭部とすることにより、前記ピンを前記受け入れ側の骨に装着したときに、前記頭部が前記受け入れ側の骨に埋没する危険性を減じるようにしてあることを特徴とする請求の範囲第９項に記載のピン。By making the head a hexagonal head outside, the risk of the head being buried in the receiving bone when the pin is attached to the receiving bone is reduced. The pin according to claim 9, wherein the pin is a pin. 前記尖端部は前記頭部に対向する前記トンネルの側面において前記受け入れ側の骨の一部に刺入するように尖らせてあることを特徴とする請求の範囲第９項に記載のピン。The pin according to claim 9, wherein the pointed portion is sharpened so as to be inserted into a part of the bone on the receiving side on a side surface of the tunnel facing the head. 受け入れ側の骨の開口部内に骨又は組織移植片を保定するためのピンであって、前記ピンは前記受け入れ側の骨の外部を貫通し、前記開口部及び前記移植片を貫通する延在部を挿入するために提供され、前記ピンは前記受け入れ側の骨の外部に位置させる近心端と、前記受け入れ側の骨の内部に配置するテーパー状の遠心端と、中間の本体部分とを有し、前記ピンは打ち込み工具により係合させる前記近心端に配置した頭部と、前記受け入れ側の骨と係合させるため前記近心端に隣接したねじ切り部分とを有し、前記中間の部分は前記ねじ切りした部分に隣接する一点から前記遠心端に隣接する一点まで直径が小さくなるテーパー状にしてあり、そのテーパー度合いは前記遠心端とは異なることを特徴とするピン。A pin for retaining a bone or tissue graft in an opening of a receiving bone, the pin penetrating outside the receiving bone and extending through the opening and the graft And the pin has a mesial end located outside the receiving bone, a tapered distal end located inside the receiving bone, and an intermediate body portion. The pin has a head disposed at the mesial end for engagement by a driving tool and a threaded portion adjacent to the mesial end for engagement with the receiving bone, the intermediate portion Has a taper shape with a diameter decreasing from one point adjacent to the threaded portion to one point adjacent to the distal end, and the degree of taper is different from that of the distal end. 前記ピンは前記ねじ切りした部分と前記頭部との間に直径の小さい部分を含むことを特徴とする請求の範囲第15項に記載のピン。16. The pin according to claim 15, wherein the pin includes a portion having a small diameter between the threaded portion and the head. 前記ピンの前記遠心端は一般に円錐形の形状を有することを特徴とする請求の範囲第15項に記載のピン。16. A pin according to claim 15, wherein the distal end of the pin has a generally conical shape. 前記一般に円錐形の遠心端は約30゜の角度に角度づけしていることを特徴とする請求の範囲第17項に記載のピン。18. A pin according to claim 17, wherein said generally conical distal end is angled at an angle of about 30 degrees. 前記頭部を外部が六角形の頭部とすることにより、前記ピンを前記受け入れ側の骨に装着した時に前記受け入れ側の骨に前記頭部が埋没する危険性を減じるようにしてあることを特徴とする請求の範囲第15項に記載のピン。By making the head a hexagonal head outside, the risk of the head being buried in the receiving bone when the pin is attached to the receiving bone is reduced. 16. The pin according to claim 15, characterized in that it is a pin. 更に、前記開口部の前記頭部とは反対側で前記受け入れ側の骨の一部に刺入させるために尖らせた尖端部を前記ピンの前記テーパー状の遠心端に形成されてなることを特徴とする請求の範囲第15項に記載のピン。Further, a sharpened tip end is formed on the tapered distal end of the pin so as to be inserted into a part of the bone on the receiving side opposite to the head portion of the opening. 16. The pin according to claim 15, characterized in that it is a pin. 受け入れ側の骨のトンネルの内部に移植靭帯を固定するためのピンであって、
前記受け入れ側の骨と係合して、前記受け入れ側の骨に前記ピンを固定するためのねじ切りした部分を含み、前 記移植靭帯を前記トンネルの側壁に対して圧接すること で、前記移植靭帯をトンネル内部に固定し前記靭帯の治 癒を促進するために前記移植靭帯と係合しくさび式に止 めるための手段を含む本体部分を有し、
ここで前記移植靭帯と係合しくさび式に止める手段は、前記ねじ切りした部分に直接隣接する平滑な表面を有し、
前記本体部分は更に、前記係合しくさび式に止める手段に一端が近接するテーパー状の先端部分を含んでおり、
前記ピンは更に、前記ねじ切りした部分に接する前記本体部分の端部に結合し、前記ピンを前記受け入れ側の骨に打ち込むための頭部を含むことを特徴とするピン。A pin for fixing the graft ligament inside the bone tunnel on the receiving side,
It engages the bone of the receiving side comprises a threaded portion for securing the pin to the bone of the receiving side, by a front Symbol graft ligament to be pressed against the side walls of the tunnel, the graft ligament the has a body portion including means for stopping Mel in the graft ligament engaging wedge type to fixed inside the tunnel to promote Osamu healing of the ligament,
Wherein the means for engaging and wedge-engaging with the graft ligament has a smooth surface directly adjacent to the threaded portion;
The body portion further includes a tapered tip portion having one end proximate to the engaging and wedge-fastening means;
The pin further comprising a head coupled to an end of the body portion that contacts the threaded portion and for driving the pin into the receiving bone. 受け入れ側の骨の開口部内に骨又は組織移植片を保定するためのピンであって、前記ピンは前記受け入れ側の骨の外部を貫通し、前記開口部及び前記移植片を貫通する延在部を挿入するために提供され、前記ピンは前記受け入れ側の骨の外部に位置させる近心端と、前記受け入れ側の骨の内部に配置するテーパー状の遠心端と、中間の本体部分とを有し、前記ピンは打ち込み工具により係合させる前記近心端に配置した頭部と、前記受け入れ側の骨と係合させるため前記近心端に隣接したねじ切り部分とを有し、前記中間の部分は平滑であって前記ねじ切りした部分に隣接する一点から前記遠心端に隣接する一点まで直径が小さくなるテーパー状にしてあり、そのテーパー度合いは前記遠心端とは異なることを特徴とするピン。A pin for retaining a bone or tissue graft in an opening of a receiving bone, the pin penetrating the exterior of the receiving bone and extending through the opening and the graft And the pin has a mesial end located outside the receiving bone, a tapered distal end located inside the receiving bone, and an intermediate body portion. The pin has a head disposed at the mesial end for engagement by a driving tool and a threaded portion adjacent to the mesial end for engagement with the receiving bone, the intermediate portion Is a pin which is smooth and has a tapered shape whose diameter decreases from one point adjacent to the threaded portion to one point adjacent to the distal end, and the degree of taper is different from that of the distal end.
JP51636594A 1993-01-15 1994-01-13 Pin to fix the graft ligament to the bone Expired - Fee Related JP3637369B2 (en)

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PCT/US1994/000634 WO1994015552A1 (en) 1993-01-15 1994-01-13 Pin for securing a replacement ligament to a bone

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EP0695155A4 (en) 1996-12-04
CA2153594C (en) 1998-12-15
WO1994015552A1 (en) 1994-07-21
AU7037796A (en) 1997-01-16
AU670677B2 (en) 1996-07-25
JPH08505549A (en) 1996-06-18
US5397356A (en) 1995-03-14
AU6030594A (en) 1994-08-15
CA2153594A1 (en) 1994-07-21
DE69425491T2 (en) 2001-02-08
DE69425491D1 (en) 2000-09-14
ATE195241T1 (en) 2000-08-15
EP0695155A1 (en) 1996-02-07
EP0695155B1 (en) 2000-08-09
US5562671A (en) 1996-10-08

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